Coronary artery bypass surgery is a procedure that makes way for the blood to find its way around a blocked or partially blocked artery in the heart. The arteries that lead to the heart are known as coronary arteries, from which the procedure’s name is derived.
Coronary artery disease (CAD) is the term given to the narrowing of the coronary arteries. They are blood vessels that supply much-needed oxygen and nutrients to the heart muscle. The underlying cause of CAD is the build-up of fatty material on the artery walls. If the build-up continues unchecked, it narrows the arteries and limits the amount of oxygen-rich blood reaching the heart.
Alternatively, this procedure is also called coronary artery bypass grafting(CABG) or simply heart bypass surgery.
Symptoms of coronary artery disease may include:
● Chest pain.
● Fatigue or abnormally low energy.
● General feelings of unease.
● Abnormal heart rhythms.
● Shortness of breath.
● Hands and feet may experience swelling.
● Indigestion.
When does the need for coronary artery bypass surgery arise?
Your doctor may present coronary artery bypass surgery should you have:
● Excess blockage and subsequent narrowing of the coronary artery.
● Consistent and overwhelming chest pain caused when multiple heart arteries narrow down.
● Multiple affected arteries and malfunctioning heart chambers.
● A blocked heart artery that does not respond to a less-invasive treatment such as an angioplasty. This procedure uses a balloon and catheter to widen the artery. A small tube known as a stent is used to keep the artery clear of blockage.
How is Coronary Artery Disease Treated?
Making use of a healthy blood vessel from elsewhere in the body is a viable option for treating blocked or narrowed arteries as it helps bypass the obstructed portions of the coronary artery. This process is known as grafting, and the blood vessels used for the graft generally may be a portion of the artery from the arm or chest or veins from the legs. The surgeon fixes one end of the graft before the blockage and the other where the blockage ends.
The newly created pathway enables the blood to bypass the blockage by traveling through the graft put in place and reaching the heart.
Pre-operative procedure:
As CABG can be a crucial procedure whose outcome affects the patient’s quality of life, the concerned individual must first undergo a battery of tests to help ensure a smooth surgery.
Imaging and lab tests:
The potential tests include imaging and other lab tests such as:
● Electrocardiogram.
● Echocardiogram.
● Exercise stress test.
● Computed tomography (CT) scan angiography.
● Lab tests, such as a complete blood count, for analyzing cholesterol and blood sugar levels. Other possible tests may include testing the urine as well as kidney function.
Coronary Artery Bypass Grafting(CABG) Procedure:
With CABG being an elaborate procedure, it can take several hours to complete. The surgery’s actual duration depends on the surgery’s type and the extent of the blockage. The following are the usual steps in most bypass surgeries.
● Anaesthesia and life support: Like most major surgeries, the first step is to render the patient unconscious by administering an anaesthetic. This medication will keep the patient from experiencing any pain during the surgery. When the more traditional “open heart” CABG is carried out, the heart is stopped, and a heart-lung machine takes over the task of pumping blood through the body.
● Intravenous lines. Intravenous (IV) lines are used during the procedure to infuse necessary medication through the patient’s veins.
● Blood vessel harvesting: The CABG procedure uses blood vessels from elsewhere in the body, usually an artery or a vein from either the arm, leg, or chest. Next, the blood vessel is used to give the blood an alternate pathway to the heart, skipping the blocked portion entirely.
● Surgery: The traditional bypass surgery is done by making the required incision in the chest to access the heart. Once the heart is exposed, the surgeon will carry out the bypass procedure. The blood vessel will be latched onto the aorta and end just past the portion with the blockage.
Variations of bypass surgery:
There are certain approaches to bypass or CABG surgery that the surgeon may resort to depending on the patient’s needs. Some of these alternative methods include:
○ Off-pump CABG: With this kind of CABG, the surgeon doesn’t make use of the heart-lung machine but operates while the heart is still beating.
○ Minimally invasive CABG: Surgeons may also recommend a minimally invasive CABG where only smaller incisions are made to perform the surgery. Making use of this alternative will help reduce post-operative pain and recovery time.
○ Robot-assisted CABG: Robotic-assisted CABG is bypass surgery done through tiny incisions in the chest, using surgical instruments and a camera attached to robotic arms. The heart surgeon controls the machine via a console.
Thanks to the smaller incisions, there is less scarring as well as reduced pain and less dependence on pain-relieving medication following the surgery. Robotically-assisted CABG surgery could also reduce the duration of the stay in the hospital and a quicker return to daily life.
○ Hybrid approach: A hybrid approach to treating heart ailments combines CABG along with other techniques. The surgeon may resort to robot-assisted CABG on one artery, and non-CABG options such as stenting for the other artery if necessary.
Post-operative care:
After undergoing the bypass, it is normal to feel sore and disoriented once the effect of the anaesthesia wears off. Post-operative usually includes:
● Using a breathing tube inserted in your throat to help with breathing through a ventilator until you are stable enough to breathe on your own.
● It is normal to spend up to 2 days in the hospital’s intensive care unit after the surgery. How long you stay at the hospital depends on the pace of recovery or the appearance of any unexpected complications. You will be closely monitored and hooked up to a machine that monitors your heart 24/7.
● Medicines will be administered intravenously to help manage pain and prevent blood clots.
● Cardiac rehabilitation, or cardiac rehab for short, is the supervised counseling and exercise program that will help improve heart health after the bypass surgery. You will be encouraged to move around while still at the hospital and continue the program at home.
Tips for Maintaining a Healthy Heart:
A healthy lifestyle is vital to prevent blocked arteries following heart surgery. Here are some suggestions to keep the fat and cholesterol out of your diet so they don’t build up again.
● Avoid fried and high-fat foods: When you consume fatty foods, the fat makes its way to the blood vessels and sticks to the walls. Over time it forms a hard, sticky plaque and ends up clogging the blood vessels, the very reason for the bypass procedure. Foods rich in fat and cholesterol to avoid are whole milk, dairy products, high-fat meats, and baked desserts.
● Keep an eye on your weight: Keeping the body weight in the optimal range is vital for a healthy heart. Be sure to check and keep track of your weight regularly. Utilise exercise to keep the weight down and as it helps minimize the risk of heart disease. Aerobic exercises such as walking, jogging, or swimming are ideal. Consult your doctor for a suitable exercise regimen.
● Take steps to manage your stress and prevent depression: Mental and emotional health directly affects physical health. It is possible to feel some levels of anxiety and depression after the surgery. You can keep both under control by staying socially active, getting plenty of sleep, or being a part of a support group.
Cost of Coronary Artery Bypass Surgery in India:
India can lay claim to some of the best medical care facilities, making the country a prime destination for medical tourism. The quality of India’s healthcare facilities and experienced doctors and surgeons whose services are significantly lower than what an international patient would pay in their home country.
The average bypass surgery cost in India can vary from INR 1,50,000 to INR 5,00,000 (USD 1800 – USD 6000). Naturally, the total financial obligation will depend on the choices the individual makes, but the average CABG surgery cost in India, as it is alternatively known as is around INR 2,50,000 (USD 3000).
Medical tourism does comes with potential challenges, such as cultural differences, and it would be worthwhile considering this and all aspects before settling on a destination. With its robust medical tourism industry and English-speaking population, India would be a natural choice should the need arise.
Frequently Asked Questions about Atrial Septal Defect Closure
Is Atrial Septal Defect closure safe?
Secundum closure with a transcatheter device ASD is a maturing technology that has been around for more than a decade. This technique has gained popularity as a non-surgical alternative to surgery, and it is generally considered to be safe and successful.
With an Atrial Septal Defect, is it possible to live a normal life?
Several patients have been known to live for 80 years or longer with massive unrepaired flaws without experiencing serious handicaps.
How long does an Atrial Septal Defect closure take?
It will take roughly 2 hours to complete the repair. A small, flexible tube (catheter) will be inserted into an artery in the groin by the healthcare provider. A little device will be contained within this tube.
Is it possible to heal a hole in the heart without surgery?
Previously, closing an Atrial Septal Defect (ASD) required open-heart surgery through a chest incision and the use of a heart-lung bypass machine. The recovery time for this treatment would be three to five days in the hospital. ASDs can now be closed without the need for surgery.
Is Atrial Septal Defect inherited?
The majority of ASD instances are not hereditary and happen by accident. Autosomal dominant inheritance appears to be present in some circumstances. Small ASDs may not require treatment because they usually resolve on their own. Open heart surgery or cardiac catheterization are used to close larger ASDs in children.
Is ASD a life-threatening condition?
The heart and lungs can be damaged by a significant Atrial Septal Defect that has been present for a long period. Chest pain, abnormal heart enlargement, irregular heartbeats (arrhythmias), heart failure, and heart fluttering (atrial fibrillation), are all life-threatening symptoms of ASD in extreme cases.
Is it possible for a hole in the heart to trigger a stroke?
A stroke is not caused by a hole in the heart. Rather, the hole allows a minute blood clot to flow from the right to the left side of the heart, causing a stroke if it travels to the brain.
Is it possible to live a regular life while having a hole in the heart?
Yes, it’s possible to go through life with a hole in the heart without even realizing it.
Is it possible for a closed hole in the heart to reopen?
It is very unlikely that a closed hole would reopen. There are currently no drugs that can be used to close the hole. If a child has an Atrial Septal Defect, the doctor may want to keep an eye on him or her for a while to see if the hole closes on its own. During this time, the health care provider may use medicine to treat symptoms.
What are the signs and symptoms of a heart hole?
Some of the signs and symptoms include swelling of the legs, abdomen, or feet. It also includes shortness of breath, fatigue, irregular heartbeats, heart murmur, etc.
